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General NPI Number Information
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NPI Number | 1821157504
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Entity Type | Individual
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Provider Name | CARMEN ANITA SHIRLEY MD
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Gender | Female
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 110 FRONT ST FL 6
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City | JUPITER
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State | FL
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Zip | 33477-5095
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Country | US
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Telephone | 210-495-0224
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Fax | 210-247-9326
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Provider Business Mailing Address
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Address Line | 110 FRONT ST FL 6
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City | JUPITER
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State | FL
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Zip | 33477-5095
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Country | US
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Telephone | 210-495-0224
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Fax | 210-247-9326
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number | ME67429
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License Number State | FL
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